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Current Opinion in Critical Care Feb 2019This review focuses on the emerging body of literature regarding the management of acute respiratory failure in low- and middle-income countries (LMICs). The aim is to... (Review)
Review
PURPOSE OF REVIEW
This review focuses on the emerging body of literature regarding the management of acute respiratory failure in low- and middle-income countries (LMICs). The aim is to abstract management principles that are of relevance across a variety of settings where resources are severely limited.
RECENT FINDINGS
Mechanical ventilation is an expensive intervention associated with considerable mortality and a high rate of iatrogenic complications in many LMICs. Recent case series report crude mortality rates for ventilated patients of between 36 and 72%. Measures to avert the need for invasive mechanical ventilation in LMICs are showing promise: bubble continuous positive airway pressure has been demonstrated to decrease mortality in children with acute respiratory failure and trials suggest that noninvasive ventilation can be conducted safely in settings where resources are low.
SUMMARY
The management of patients with acute respiratory failure in LMICs should focus on avoiding intubation where possible, improving the safety of mechanical ventilation and expediting weaning. Future directions should involve the development and trialing of robust and context-appropriate respiratory support technology.
Topics: Child; Continuous Positive Airway Pressure; Humans; Noninvasive Ventilation; Respiration, Artificial; Respiratory Distress Syndrome; Respiratory Insufficiency
PubMed: 30531535
DOI: 10.1097/MCC.0000000000000568 -
Jornal Brasileiro de Pneumologia :... 2015Patients with obstructive lung disease often require ventilatory support via invasive or noninvasive mechanical ventilation, depending on the severity of the... (Review)
Review
Patients with obstructive lung disease often require ventilatory support via invasive or noninvasive mechanical ventilation, depending on the severity of the exacerbation. The use of inhaled bronchodilators can significantly reduce airway resistance, contributing to the improvement of respiratory mechanics and patient-ventilator synchrony. Although various studies have been published on this topic, little is known about the effectiveness of the bronchodilators routinely prescribed for patients on mechanical ventilation or about the deposition of those drugs throughout the lungs. The inhaled bronchodilators most commonly used in ICUs are beta adrenergic agonists and anticholinergics. Various factors might influence the effect of bronchodilators, including ventilation mode, position of the spacer in the circuit, tube size, formulation, drug dose, severity of the disease, and patient-ventilator synchrony. Knowledge of the pharmacological properties of bronchodilators and the appropriate techniques for their administration is fundamental to optimizing the treatment of these patients.
Topics: Administration, Inhalation; Bronchodilator Agents; Drug Delivery Systems; Female; Humans; Lung; Male; Nebulizers and Vaporizers; Pulmonary Disease, Chronic Obstructive; Respiration, Artificial
PubMed: 26578139
DOI: 10.1590/S1806-37132015000000035 -
Seminars in Perinatology Mar 2024Tremendous advancements in neonatal respiratory care have contributed to the improved survival of extremely preterm infants (gestational age ≤ 28 weeks). While... (Review)
Review
Tremendous advancements in neonatal respiratory care have contributed to the improved survival of extremely preterm infants (gestational age ≤ 28 weeks). While mechanical ventilation is often considered one of the most important breakthroughs in neonatology, it is also associated with numerous short and long-term complications. For those reasons, clinical research has focused on strategies to avoid or reduce exposure to mechanical ventilation. Nonetheless, in the extreme preterm population, 70-100% of infants born 22-28 weeks of gestation are exposed to mechanical ventilation, with nearly 50% being ventilated for ≥ 3 weeks. As contemporary practices have shifted towards selectively reserving mechanical ventilation for those patients, mechanical ventilation weaning and extubation remain a priority yet offer a heightened challenge for clinicians. In this review, we will summarize the evidence for different strategies to expedite weaning and assess extubation readiness in preterm infants, with a particular focus on extremely preterm infants.
Topics: Infant; Infant, Newborn; Humans; Respiration, Artificial; Ventilator Weaning; Airway Extubation; Infant, Extremely Premature; Neonatology
PubMed: 38553331
DOI: 10.1016/j.semperi.2024.151890 -
Heart & Lung : the Journal of Critical... 2015Mechanical ventilation (MV) causes many distressing symptoms. Weaning, the gradual decrease in ventilator assistance leading to termination of MV, increases respiratory... (Review)
Review
Mechanical ventilation (MV) causes many distressing symptoms. Weaning, the gradual decrease in ventilator assistance leading to termination of MV, increases respiratory effort, which may exacerbate symptoms and prolong MV. Music, a non-pharmacological intervention without side effects may benefit patients during weaning from mechanical ventilatory support. A narrative review of OVID Medline, PsychINFO, and CINAHL databases was conducted to examine the evidence for the use of music intervention in MV and MV weaning. Music intervention had a positive impact on ventilated patients; 16 quantitative and 2 qualitative studies were identified. Quantitative studies included randomized clinical trials (10), case controls (3), pilot studies (2) and a feasibility study. Evidence supports music as an effective intervention that can lesson symptoms related to MV and promote effective weaning. It has potential to reduce costs and increase patient satisfaction. However, more studies are needed to establish its use during MV weaning.
Topics: Anxiety; Humans; Music; Patient Satisfaction; Respiration, Artificial; Ventilator Weaning
PubMed: 26227333
DOI: 10.1016/j.hrtlng.2015.06.010 -
Respiratory Care Apr 2003Both invasive and noninvasive mechanical ventilation techniques are inherent to the care of most patients admitted to intensive care units. Despite the everyday use of... (Review)
Review
Both invasive and noninvasive mechanical ventilation techniques are inherent to the care of most patients admitted to intensive care units. Despite the everyday use of mechanical ventilation for thousands of patients and the availability of thousands of reports in the medical literature, there are no clear and consistent guidelines for the use of mechanical ventilation for pediatric patients. In many areas data are lacking, and in other areas data are extrapolated from studies performed with adult subjects. Despite the variability in views about mechanical ventilation, 2 themes are consistent. First, modern pediatric respiratory care requires a substantial institutional commitment for state-of-the-art management of the mechanically ventilated patient. Second, a team approach involving physicians, nurses, and respiratory therapists is essential. This review highlights some of the major issues affecting the pediatric patient who requires invasive or noninvasive mechanical ventilation. These issues are pertinent to critical care clinicians because one of the most common reasons for admission to an intensive care unit is the need for mechanical ventilation. Furthermore, the duration of mechanical ventilation is one of the major determinants of the duration and cost of an intensive care unit stay.
Topics: Child; Humans; Intensive Care Units, Pediatric; Intubation, Intratracheal; Length of Stay; Positive-Pressure Respiration; Respiration, Artificial; Respiratory Insufficiency; Treatment Outcome; Ventilator Weaning; Ventilators, Mechanical
PubMed: 12667269
DOI: No ID Found -
Anesthesiology May 2024
Topics: Respiration, Artificial
PubMed: 38592353
DOI: 10.1097/ALN.0000000000004927 -
Critical Care (London, England) May 2024Mechanical ventilation, a lifesaving intervention in critical care, can lead to damage in the extracellular matrix (ECM), triggering inflammation and ventilator-induced... (Review)
Review
BACKGROUND
Mechanical ventilation, a lifesaving intervention in critical care, can lead to damage in the extracellular matrix (ECM), triggering inflammation and ventilator-induced lung injury (VILI), particularly in conditions such as acute respiratory distress syndrome (ARDS). This review discusses the detailed structure of the ECM in healthy and ARDS-affected lungs under mechanical ventilation, aiming to bridge the gap between experimental insights and clinical practice by offering a thorough understanding of lung ECM organization and the dynamics of its alteration during mechanical ventilation.
MAIN TEXT
Focusing on the clinical implications, we explore the potential of precise interventions targeting the ECM and cellular signaling pathways to mitigate lung damage, reduce inflammation, and ultimately improve outcomes for critically ill patients. By analyzing a range of experimental studies and clinical papers, particular attention is paid to the roles of matrix metalloproteinases (MMPs), integrins, and other molecules in ECM damage and VILI. This synthesis not only sheds light on the structural changes induced by mechanical stress but also underscores the importance of cellular responses such as inflammation, fibrosis, and excessive activation of MMPs.
CONCLUSIONS
This review emphasizes the significance of mechanical cues transduced by integrins and their impact on cellular behavior during ventilation, offering insights into the complex interactions between mechanical ventilation, ECM damage, and cellular signaling. By understanding these mechanisms, healthcare professionals in critical care can anticipate the consequences of mechanical ventilation and use targeted strategies to prevent or minimize ECM damage, ultimately leading to better patient management and outcomes in critical care settings.
Topics: Humans; Extracellular Matrix; Respiratory Distress Syndrome; Respiration, Artificial; Lung; Ventilator-Induced Lung Injury; Matrix Metalloproteinases; Animals
PubMed: 38750543
DOI: 10.1186/s13054-024-04942-y -
European Respiratory Review : An... Jun 2023https://bit.ly/3HMWKTp
https://bit.ly/3HMWKTp
Topics: Humans; Respiration, Artificial; Noninvasive Ventilation; Respiratory Insufficiency; Respiration; Respiratory Muscles
PubMed: 37019460
DOI: 10.1183/16000617.0027-2023 -
Respiratory Care May 2017The fundamental goals of mechanical ventilation are to improve pulmonary gas exchange and relieve respiratory distress, thus permitting lung and airway healing, while at... (Review)
Review
The fundamental goals of mechanical ventilation are to improve pulmonary gas exchange and relieve respiratory distress, thus permitting lung and airway healing, while at the same time lessening the risk for iatrogenic complications. This review will summarize some of the advances in mechanical ventilation in 2016, with a particular focus on ventilator-associated clinical challenges and outcomes.
Topics: Humans; Pulmonary Gas Exchange; Respiration, Artificial; Respiratory Distress Syndrome; Ventilator Weaning; Ventilator-Induced Lung Injury
PubMed: 28442589
DOI: 10.4187/respcare.05545 -
The European Respiratory Journal May 2002Patients with chronic airflow obstruction who are difficult to wean from mechanical ventilation are at increased risk of intubation-associated complications and... (Review)
Review
Patients with chronic airflow obstruction who are difficult to wean from mechanical ventilation are at increased risk of intubation-associated complications and mortality because of prolonged invasive mechanical ventilation. Noninvasive positive pressure ventilation may revert most of the pathophysiological mechanisms associated with weaning failure in these patients. Several randomized controlled trials have shown that use of noninvasive ventilation to achieve earlier extubation in difficult-to-wean patients or in patients who develop respiratory failure after apparently successful extubation can result in reduced periods of endotracheal intubation and complication rates and improved survival. However, this is not a consistent finding, and the currently available published data with outcome as the primary variable are exclusively from patients who had pre-existing lung disease. In addition, the patients were haemodynamically stable, with a normal level of consciousness, no fever and a preserved cough reflex. It remains to be seen whether noninvasive positive pressure ventilation has a role in other patient groups and situations, such as prevention of postextubation failure or unplanned extubation. The technique is, however, a useful addition to the therapeutic armamentarium for a group of patients who pose a significant clinical and economic challenge.
Topics: Algorithms; Humans; Intubation, Intratracheal; Positive-Pressure Respiration; Pulmonary Disease, Chronic Obstructive; Respiration, Artificial; Treatment Outcome; Ventilator Weaning
PubMed: 12030739
DOI: 10.1183/09031936.02.00299702